Monday, December 30, 2013

Edward C. Liu
LegislativeAttomeyThis memorandum responds to your request for an analysis of whether
employees would be eligible for the health insurance premium tax credits
provided in 36B of the Internal Revenue Code (IRC) if they were enrolled in a
health insurance plan that was offered by their employer.

Friday, December 27, 2013

Angela Napili
Information Research SpecialistThe Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as
amended) has numerous provisions affecting private health insurance and
public health coverage programs. Many of these provisions take effect in
2014. This report provides resources to help congressional staff
respond to constituents’ frequently asked questions (FAQs) about the law.
The report lists selected resources regarding consumers, employers, and
other stakeholders, with a focus on federal sources. It also lists CRS
reports that summarize ACA’s provisions.

The report begins with links to contacts for specific ACA questions, such as
Consumer Assistance Programs, state agencies, and local organizations that
can answer constituents’ questions directly. For example, the federal
HealthCare.gov website offers an ACA consumer telephone hotline and online
chat assistance. The report also lists sources for congressional staff to contact
federal agencies with ACA questions.

The report provides basic consumer sources, including broad overviews of the
ACA law. The next sections focus on health coverage: the individual
mandate, private health insurance, and exchanges, as well as public health
care programs, such as Medicaid and the State Children’s Health Insurance
Program (CHIP), Medicare, Indian health care, and veterans’ and military
health care. The report then lists sources on employer-sponsored coverage,
including sources on employer penalties, small businesses, federal
workers’ health plans, and union health plans. The report also provides
sources on ACA’s provisions on mental health, public health,
workforce, quality, and taxes. Finally, the report lists sources on ACA
costs and appropriations, and sources for obtaining the law’s
full-text.

This list is not a comprehensive directory of all resources on the ACA, but
rather is intended to address a few questions that may arise frequently.

Date of Report: December 4, 2013
Number of Pages: 17Order Number: R43215
Price: $29.95
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CLICK: R43215.pdf
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Thursday, December 26, 2013

Kirsten J. Colello
Specialist in Health and Aging PolicyLong-term services and supports (LTSS) refer to a broad range of health and
health-related services and supports needed by individuals who lack the
capacity for self-care due to a physical, cognitive, or mental disability
or condition. Often the individual’s disability or condition results in
the need for hands-on assistance or supervision over an extended period of
time. Medicaid plays a key role in covering LTSS to aged and disabled
individuals. As the largest single payer of LTSS in the United States,
federal and state Medicaid spending accounted for $133.5 billion or 42.1%
of all LTSS expenditures in 2011 ($317.1 billion). LTSS are also a substantial
portion of spending within the Medicaid program relative to the population
served, accounting for over onethird (35.6%) of all Medicaid spending. Of
the 66 million total enrolled Medicaid population, an estimated 4.2
million (or 6.4%) Medicaid beneficiaries received LTSS in 2010.

Medicaid funds LTSS for eligible beneficiaries in both institutional and home
and communitybased settings, though the portfolio of services offered
differs substantially by state. Moreover, states are required to offer
certain Medicaid institutional services to eligible beneficiaries,
while the majority of Medicaid home and community-based services (HCBS)
are optional for states. In recent decades, federal authority has expanded
to assist states in increasing and diversifying their Medicaid LTSS
coverage to include HCBS. As a result, the share of Medicaid LTSS spending
for HCBS has more than doubled, accounting for 20.8% of Medicaid LTSS
spending in 1995 to just over half (50.6%) of total Medicaid LTSS spending
in 2011.

States now have a broad range of coverage options to select from when designing
their LTSS programs. In general, Medicaid law provides states with two
broad authorities, which either cover certain LTSS as a benefit under the
Medicaid state plan or cover home and community-based LTSS through a
waiver program which permits states to ignore certain Medicaid requirements
in the provision of these services. Given the range of available coverage
options, states continue to enhance or expand their LTSS delivery systems
to cover additional services or target services to specific populations
with a focus on HCBS. In FY2012 and FY2013, states reported
expanding their state plan benefits to include HCBS through the Section
1915(i) HCBS state plan option, the Section 1915(k) Community First Choice
(CFC) option, and Programs for All-Inclusive Care of the Elderly (PACE).
States also reported adopting new HCBS waiver programs or
expanding existing waivers to include additional services. Finally, states
reported efforts to implement demonstrations and other grant activities to
enhance or expand their LTSS delivery systems under the Money Follows the
Person (MFP) Rebalancing Demonstration and the Balancing
Incentive Payments (BIP) Program, as well as efforts to implement or
expand the financing and delivery of Medicaid LTSS through managed care
arrangements.

This report provides a description of the various statutory authorities that
either require or otherwise allow states to cover LTSS under Medicaid. The
Appendix provides a brief legislative history of Medicaid LTSS from
Medicaid’s enactment and initial coverage requirements for institutional
care through the evolution of HCBS options available to states. A discussion
of changes to Medicaid made by the Patient Protection and Affordable Care
Act (ACA, P.L. 111- 148, as amended) with respect to LTSS coverage options
is also provided.

Date of Report: December 5, 2013
Number of Pages: 32Order Number: R43328
Price: $29.95
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